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March 4, 2020

A Friendly Atheist headline directed me to a righteous rant on religious freedom. AOC: The GOP Only Ever Invokes “Religious Freedom” When It Wants to Justify Hate, the headline read. It seems that during a hearing in the U.S. House last week, Rep. Alexandria Ocasio-Cortez said the following:

There is nothing holy about rejecting medical care of people, no matter who they are, on the grounds of what their identity is. There is nothing holy about turning someone away from a hospital. There’s nothing holy about rejecting a child from a family. There’s nothing holy about writing discrimination into the law, and I am tired of communities of faith being weaponized and being mischaracterized, because the only time religious freedom is invoked, it’s in the name of bigotry and discrimination. I’m tired of it.

Huh, I thought. Huh.

I’ve long been tired of the way the Right talks about religious freedom, but I’ve rarely seen the problems with the Right’s religious freedom framework stated so simply and directly. The only time religious freedom is invoked, it’s in the name of bigotry and discrimination, AOC said. And you know what? It’s true.

Here, I’ll make a list of evangelicals’ religious freedom claims.

  • Bakers should be able to deny service to gay couples.
  • Catholic groups should be able to deny employees health insurance that covers birth control.
  • Doctors should be able to deny treatment to transgender individuals.
  • Religious groups should be able to deny adoptions to gay and lesbian couples.
  • Private schools should be able to fire gay teachers.

Are you sensing a pattern? I sure am.

I grew up in a conservative evangelical home in the 1990s and early 2000s, and I don’t remember hearing a lot about religious freedom. My impression, based on my own experience, is that “religious freedom” took off as a catchphrase on the Right at the same time that LGBTQ rights became increasingly accepted by the mainstream. From where I’m standing, calls for “religious freedom” look more like a claim developed specifically to discriminate against LGBTQ people than anything else.

It also makes a handy argument for denying people health insurance that covers contraceptives, of course. Still, overall, religious freedom claims’ primary target seems to be LGBTQ individuals.

See, I’m not sure the Right is actually as full-throated in its support for religious freedom as it claims. After all, what does the Right not include in its catalogue of religious freedom? Quite a lot, as it turns out.

  • The American Family Association’s Bryan Fischer called explicitly for a ban on new mosque construction. In some places in the U.S., conservatives have successfully blocked the construction of new mosques.
  • Evangelicals voted overwhelmingly for a man who called for a “Muslim ban” on U.S. immigration. Evangelical leader Franklin Graham was vocal in his support of this proposal.
  • Evangelicals tried to ban Harry Potter books from school libraries on the grounds that they contained witchcraft—which, even if they had, what about witches’ religious freedom?

I should be clear that there are evangelicals who do support religious freedom, just as there are evangelicals who oppose Donald Trump. See, for example, the evangelical Left. But then there’s the whole conservative wing of evangelicalism, the wing that is sometimes identified as “fundamentalist” and has gone all-in for Trump.

Recall that those evangelicals—the conservative ones I’m talking about—still want to put Christian prayer back in school, because we’re a Christian nation, dammit. That is not a religious freedom argument. It’s a religious dominance argument. This wing of evangelicals doesn’t believe in religious freedom for anyone but Christians.

Remember, these are the same people who argue that our founding fathers established our country as an explicitly Christian nation and call openly for Christian preference. These are the same people who want school board meetings and city council meetings to open in Christian prayers. They don’t want religious freedom. That’s just a smokescreen they use to justify their bigotry. What they want is religious dominance.

AOC’s comments remind us that this issue isn’t all that complicated. It’s actually really, really simple.

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December 11, 2019

After yesterday’s post I went looking for women’s suffrage cartoons, and came upon this one, from the UK:

The point being, this well-dressed, upper class woman can clearly be trusted to make a more informed, responsible choice at the ballot box than this sloppily dressed, patched, Cockney accented man, so why can he vote while she can’t? That’s … yeah I’ll just say it. That’s classist. And more than a little cringe inducing.

There’s a version of this that was published in the U.S., too:

It’s not just the Irish man and the black man who are being derided as unworthy of the ballot box—there’s also the rich banker and the knock-kneed woodsman. And I imagine the other men there are meant to be stereotypes too. Still, the idea that white women needed to have the vote to counteract uneducated votes by Irish men and black men, among others, was a pro-suffrage argument.

These messages were intentional and carefully tailored:

Both the NWP and NAWSA created and perpetuated a singular image of a woman suffragist. The ideal was white, young, educated, and middle-class. Most active suffragists were middle-class women who had received higher education at universities like Vassar. Suffragists so desperately wanted to distance themselves from the poor that they proposed a float for a 1913 parade that included hobos. “Tramps,” one article for the Chicago Tribune wrote, “to appear in Washington, D.C. as horrible example.” The float was intended to show that uneducated, unmotivated homeless people had more political authority than women with degrees and ambitions. The woman suffragists wanted to find “four or five of the toughest hobos” near the nation’s capital to sport a sign reading, “but we kin vote.” The float never made it into the parade, but the suffragists clearly resented their relative lack of political rights.

This one confused me for a bit, and I can’t say I’ve completely figured it out yet:

The text under the image reads “Savagery to ‘Civilization'” and “The Indian Women: We whom you pity as drudges reached centuries ago the goal that you are now nearing.”

The plaque to the right of the image reads:

WE, THE WOMEN OF THE IROQUOIS:

Own the land, the lodge, the children.
Ours is the right of adoption, of life or death;
Ours is the right to raise up and depose chiefs;
Ours is the right of representation at all councils;
Ours the right to make and abrogate treaties;
Ours the supervision over domestic and foreign policies;
Ours the trusteeship of the tribal property;
Our lives are valued again as high as man’s.

Is the argument that Native American women were the real civilized ones all along? Or is the argument that women’s suffrage would take society down into savagery? Or something else entirely?

According to one website:

In this picture, Native American Iroquois women overlook women marching under a “Woman Suffrage” banner. In the text box, it lists the rights of Iroquois women, noting they have the political agency that is desired by suffragists. The title “Savagery to ‘civilization,’” is meant to emphasize how Native Americans were viewed as “uncivilized,” but provided more rights and equality to its members.

Even if the intent is to nod positively toward women’s rights among the Iroquois, this use of Native Americans in a promotional like this at a time when Native American children were being stolen from their parents and imprisoned in boarding schools where they were forced to give up their culture feels … off. The image was published in 1914, which means it came shortly after the end of the “Indian Wars” in the American West, which were replete with horrific massacres of Native Americans.

It strikes me as very wrong to use someone’s culture as an argument without also taking a strong stance against the annihilation of that people and their culture.

I’ll finish on less of a dark note:

Is it just me, or is there some serious male fragility on display here?

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August 31, 2019

Saturday Link Love is a feature where I collect and post links to various articles I’ve come upon over the past week. Feel free to share any interesting articles you’ve come along as well! The more the merrier!

A Losing Fight to Keep Schools Desegregated, on Education Week—“More than 43,000 school-age children in Wake County attended private schools, home schools, or charter schools in the 2017-18 school year.”

America’s Other Original Sin, on Slate—“Europeans didn’t just displace Native Americans—they enslaved them, and encouraged tribes to participate in the slave trade, on a scale historians are only beginning to fathom.”

Liberal Jews: Stop Trying To Prove You’re Loyal. Disloyalty Makes Us Great, on Forward—“If Jewish loyalty is conditional on Jews supporting American institutions, being pro-military and having political views within the accepted bipartisan consensus, then acceptance of American Jews is always conditional.”

To Lawmakers, Florida’s First All-Charter School District Is ‘A Success Story.’ But Is It Really? on WJCT—“Now, the only public schools left in Jefferson County are charter schools, funded with taxpayer dollars but operated by a private organization from South Florida instead of a local school board chosen by voters.”

The fake baby Instagram adoption scam, on the BBC—“When US couples want to adopt a baby they often post ads online and search social media for women pregnant with a child they aren’t planning to keep. Sometimes it works – but there are dangers. One young scammer has tricked countless couples, just for fun, by stealing the identity of a pregnant woman.”

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June 13, 2019

What the blazes is this?

Dave Hayes, a self-declared prophet, Christian author, and online activist who is better known as the “Praying Medic,” hosted a livestream on Saturday in which he proclaimed that Christians are going to have to rethink their conception of the End Times because President Trump is on the verge of creating a literal utopia on earth.

I … what?

Hayes argued that the contemporary interpretation of the events depicted in the book of Revelation, in which things grow worse and more corrupt as the return of Christ nears, is faulty and was crafted at a time when the world was regularly going through massive global conflicts. The many evangelical Christians who have been taught that version of the End Times, Hayes insisted, have been misled because “now we are past that” and are actually living in a world that is increasingly heading toward utopia, thanks to Trump.

This is beyond fascinating.

I should start by clarifying that I don’t think Hayes necessarily holds a particularly widespread view on this. That said, I do think we need to talk about this, because Hayes’ ideas of how Christians ended up with their current End Times theology is both spot on and completely wrong.

Before I turn to that, though, I feel I should note that part of the mystique of the antichrist is supposed to be that most people won’t recognize him. If everyone knew who he was right off, that would rather change the story. If I were on antichrist-watch, then, statements like Hayes’ would make me more concerned about the possibility that Trump may be the antichrist, not less. The antichrist is supposed to have a silver tongue. People are supposed to find him convincing. People are supposed to be taken in by his rhetoric and words. Check, check, and check.

As a quick aside, it’s worth considering what Hayes believes this “utopia” will look like. I look around and see things like immigrant children being kept in cages. Hayes, in contrast, argues that Trump is ushering in an era when there will be “no sickness, no disease, no poverty, no lack of anything.” (This somehow despite the fact that the Trump administration is still fighting to repeal overturn the Affordable Care Act, with no replacement in sight. Sure.)

Is this “utopia” is meant to be limited to native-born Americans? How is this a global view? End times theology is supposed to be global. Revelation doesn’t end with “and then God made the United States into a utopia.”

Anyway! Aside over!

What of Hayes’ claims about the development of End Times theology? This is something I actually know quite a bit about, so his claim jumped out at me:

Hayes argued that the contemporary interpretation of the events depicted in the book of Revelation, in which things grow worse and more corrupt as the return of Christ nears, is faulty and was crafted at a time when the world was regularly going through massive global conflicts.

Wrong. Wrong, wrong, wrong.

Fundamentalist Christians developed dispensational premillennialism, the view of the End Times that Hayes references here, over the course of a series of prophesy conferences beginning in the 1870s. It was at these conferences in the late nineteenth and early twentieth centuries that ministers and theologians combed through Revelation and books of prophesy in the Old Testament to create the view of the End Times we are most familiar with today from Tim LaHaye’s novels. The Scofield Reference Bible, which codified and popularized dispensational premillennialism, was published in 1909.

And you know what? Everyone thought the fundamentalists were crazy! The period beginning in the 1870s, often called the Progressive Era, was marked by optimism about the future. People believed that they could fix the problems that beset society, that they could eliminate poverty and end suffering, if they only worked at it. People looked at science and technology as forces of good, and lauded the future with unparalleled confidence.

And into that, here come the fundamentalists, declaring that the world will get worse and worse, culminating in a horrific seven-year tribulation and the return of Christ! How nutty! How ridiculously laughable!

In the late nineteenth and early twentieth centuries, predominant Christian thought held that the End Times would be ushered in by the church through global evangelism and social uplift—and not just spiritual uplift. The “social gospel”—the idea that Christians could (and should) solve social issues like slums and poverty—was extremely popular. Only when Christians had rid the world of evils, creating God’s kingdom on earth, would Christ return. Most were optimistic about their generation’s potential to realize this goal.

To the people of the late nineteenth and early twentieth century, the world was getting better. It was obvious! Human progress, the application of Christian ethics through social uplift, whatever you wanted to call it—it was real and possible. Reformers were solving problems. Technology offered new and exciting tools for improving society. A new world was dawning. It was in this context that fundamentalists began declaring that the world would get worse and worse until Christ returned. This view was laughed off the stage.

Until WWI, that is. People often underestimate the extent to which WWI changed the world—and the global psyche. After WWI, when science and technology and all of the world’s learning and progress turned in on itself with extraordinary self-destructive power, fundamentalists’ End Times theology suddenly seemed almost prophetic. Those who proclaimed unending human progress were the ones who seemed laughable. It had all gone wrong.

With that context, let’s return to Hayes’ words:

Hayes argued that the contemporary interpretation of the events depicted in the book of Revelation, in which things grow worse and more corrupt as the return of Christ nears, is faulty and was crafted at a time when the world was regularly going through massive global conflicts.

Hayes is wrong that dispensationalist premillennialism was crafted “at a time when the world was regularly going through massive global conflicts.” It wasn’t. It was actually crafted at a time of great hope and optimism about the future. It is the case, however, that WWI’s sudden global turn for the worse—followed by the Great Depression, WWII, and the Cold War—appeared to legitimize this pessimistic End Times view. This apparent legitimacy may have played a role in the interpretation’s long term success and widespread adoption. It is also true that dispensationalism is not compatible with optimism, or with the world taking a decided turn for the better.

That’s why I said that Hayes was both spot on and completely wrong.

As fascinating as I find all of this on from a scholarly standpoint, I am somehow left profoundly saddened by Hayes comments. This is his desired utopia? The only thing at all resembling utopia I can think of is the strong economy, and even that has left many behind, struggling with student loan debt or a minimum wage too low to make rent. Everything else—from the instability Trump is creating abroad to his raw hatred of Central American asylum seekers (most of whom are families fleeing violence) to his walking back LGBTQ rights, his tax cuts for the rich, his constant and blatant lying, and his continued attempts to end some of the most important healthcare reforms in generations—is nothing short of dystopian.

I suppose I shouldn’t be surprised. Given how different our value systems are, it’s to be expected that my dystopia would be his utopia. Isn’t that the entire point of the Handmaid’s Tale? The leaders of Gilead set out to set up their own personal utopia, but what they created was, to everyone who didn’t share their particular beliefs and value system, a terrifying dystopia.

And maybe—just maybe—that’s why I find it far more interesting to focus on the historical accuracy (or not) of Hayes’ comments.

Before I close, let me ask something else. If individuals like Hayes are so quick to argue that the Bible should be reinterpreted based on current events—and so eager to conclude that past interpretations held for generations were made based on current events of the time and not on what the Bible actually says—how can they simultaneously claim that it is possible to know what the Bible actually says? After all, another generation might come along fifty years in the future and say “no no, those people before us had the Bible wrong.”

Yes, Hayes is one person, and I don’t think his views are very widespread at this point. But isn’t this what theologians of the End Times have always done—changed their interpretations with the times? True, I said fundamentalists developed Dispensational Premillennialism at a time when most of the world was profoundly optimistic. But it was also a time of great social change and other factors that undoubtedly influenced their interpretation. And in addition, holders of this view have woven current events into Revelation ever since, declaring FDR the antichrist in the 1930s, and, in the 1970s, assigning specific end times roles to Cold War powers that no longer exist.

Clearly, I should write more about eschatology. This is an utterly fascinating subject that may have more implications for fundamentalists’ interpretation of the Bible (and the Bible’s interpretability) than I’ve given much thought to. It’s not a surprise, at the very least, that someone (Hayes) would find a conflict between fundamentalists’ End Times theology and their current optimism in the age Trump. He’s absolutely right—it doesn’t particularly fit.

Note: The label “fundamentalist” was not coined until 1920. I referred to the attendees at the prophesy conferences that began in the 1870s as fundamentalists because it was there fundamentalism and its distinct theology was born, even if the label itself was not used until decades later. 

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May 23, 2019

If you’re anything like me, you have spent the last week and more in a slow boil as you’ve listened to reports of new anti-abortion legislation passed in Georgia, Alabama, and Missouri, among others. I’ve written about these bills several times, pointing, among other things, to a conflict between arguing that embryos and fetuses are legal people worthy of rights, and exemptions for rape and incest. But I’ve noticed a number of other things as well, and I want to take a moment to point to them.

First, this article. “Last month, my husband and I signed forms donating an embryo we had conceived to medical research,” the author explains.

In Pennsylvania (where my fertility clinic is located), a woman seeking an abortion must receive state-directed counseling designed to discourage her from the procedure. She must then wait at least 24 hours until she can continue. In other states, women are forced to undergo unnecessary and invasive ultrasounds, watch or listen to a description of the ultrasound, and hear a lecture on how the embryo or fetus is a human life. Clinics in some states must provide them with medically inaccurate information on the risks of abortion. After all that, women often cannot have an abortion without waiting an additional one to three days, depending on the state.

In contrast, all my husband and I had to do was sign a form. Our competence to choose the outcome of our embryo was never questioned. There were no mandatory lectures on gestation, no requirement that I be explicitly told that personhood begins at conception or that I view a picture of a day-five embryo. There was no compulsory waiting period for me to reconsider my decision. In fact, no state imposes these restrictions — so common for abortion patients — on patients with frozen embryos.

When I sent this article to a likeminded friend, she responded by noting that she does know people who are anti-abortion who do care about embryos. I know what she’s talking about—parents of so-called “snowflake” babies, frozen embryos who are “adopted”—implanted in a uterus and carried to term. And true enough, it would be an understatement to say that embryonic stem cell research has been controversial.

But still. There’s something to this.

It turns out that Georgia’s abortion bill last week deliberately excluded frozen embryos when it defined personhood, while including embryos in the womb—the bill determined personhood (and the full legal rights that entails) not based on unique DNA or developmental stage, but on location.

Have a look at this:

‘Natural person’ means any human being including an unborn child.

And then this:

‘Unborn child’ means a member of the species Homo sapiens at any stage of development who is carried in the womb.

Note the words “who is carried in the womb.” Per Georgia law, as it now stands, an embryo in a womb is a natural person with all of the legal rights of any other natural person; an embryo in a petri dish is not. Note, too, that the dividing line is not implantation. It is simply being in the womb. 

In Georgia, an embryo inside a woman’s body is a legal person. An identical embryo in a petri dish is not.

This calls for a quick look at embryonic development.

Three days after fertilization—the moment the embryo and sperm meet—an embryo consists of eight cells. It is generally around this time, for women using In Vitro Fertilization, that the embryo is inserted into the womb, although in some cases doctors may wait until the fifth day after fertilization to insert the embryo (at which point it is called a blastocyst).

What is an embryo conceived naturally doing three (or five) days after fertilization? Good question. Let’s take a look.

Before looking at the above chart, I had wondered idly if the issue might be implantation. Maybe, I thought, the embryo is only considered a legal person if it has implanted in the womb, something an embryo in a petri dish by definition has not done. But the fact that an embryo takes over full week to make it from fertilization to implantation suggests that this is not the case. After all, the bill defines an “unborn child” as a member of the species Homo sapiens “at any stage of development who is carried in the womb.” In other words, the defining factor is whether it is inside a woman’s body. 

In Georgia, an embryo at three days post-fertilization is classified as a natural human with full legal rights if it is floating around inside a woman’s body, but not if it is outside of a woman’s body in a fertility clinic. In each case the embryo is exactly the same. And yet, one embryo is a legal person and the other is not. I find that highly, highly odd.

I don’t particularly want anti-abortion activists regulating what fertility clinics are allowed to do with extra embryos. Some states already have concerning legal jurisprudence surrounding such embryos. But if conservatives truly believed that every embryo is a person with a soul, you’d think “snowflake” babies would be common, and not the rarity they are. You’d think people would be rushing to ban the destruction of embryos in fertility clinics. You’d think they’d be considered people too.

The second thing I want to note is this:

This shouldn’t come as a surprise, since it’s a relationship that’s been known for years, but the states with the harshest restrictions on abortions also have the worst infant mortality rates.

The correspondence is unmistakable, and not hard to explain: Those states’ governments also show the least concern for maternal and infant health in general, as represented by public policies.

Are these states rushing to determine the cause of their disproportionately high maternal and infant mortality rates? Are “pro-life” activists demanding a solution? No. No, they are not.

There is something deeper going on here, though. If every abortion-minded woman carried her pregnancy to term, you’d have 25% more babies born each year than there currently are. Do conservatives actually think our country is “full”? That’s around a million more people, each year. There are just over 10 million undocumented immigrants in the U.S. Without abortion, we would add that many more people to the U.S. each decade. So, which is it? Are we full, or do we actually have lots of room for millions more people?

Also, 25% more women giving birth means we’d need more maternity wards—and more obstetricians, more pediatricians, more daycares, more schools, and so forth. We have absolutely had times in our history when more children were born (as a percentage) than are born today; I support fully funding these services to support whatever juvenile population we have. But do Republicans? Red states were those most loathe to adopt the medicaid expansion. Their schools are underfunded; rural hospitals are shutting down; the states banning abortion have some of the highest maternal mortality rates in the U.S.

This is why some pro-choice activists have argued that those opposed to abortion access should be called not “pro-life” but “pro-forced-birth.” If these states had a truly pro-life ethic, they would have excellent healthcare, especially low infant and maternal mortality rates, well-funded schools, and robust social programs. But they don’t.

I identified as solidly pro-life up until my junior year of college. I was passionate; I truly believed that abortion involved murdering babies.

And yet, if you’d asked me whether I’d save a crying three-year-old or a dish of embryos from a burning building, I would probably have struggled to answer. I would say embryos were people—I believed that life began at conception—but there was still a disconnect in terms of how the practical implications felt.

I was also very, very against anything that smacked of socialism. Women shouldn’t have sex if they couldn’t afford to have a child, I would have told you. Or, perhaps, I would have pointed to adoption as a solution for women who couldn’t afford to raise children. I would not have realized how heartless this sounded.

The problem was that for me, at the time, rules mattered more than people.

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March 12, 2019

A Rewire investigation into public hospitals denying women abortions is frankly horrifying.

Have a look:

When she arrived at the public hospital in Texas, the woman was so sick she couldn’t walk. About four months pregnant, she needed an abortion to save her life. A previous pregnancy had led to heart failure. This time she faced a higher risk of death from cardiac arrest that increased as the pregnancy advanced.

But the hospital’s leadership denied her the abortion she needed.

“It was decided that she was not going to be dying at that moment,” Dr. Ghazaleh Moayedi, who cared for the patient, told Rewire.News. “It really was almost a cruel joke: that she wasn’t really dead enough to warrant intervention.”

A case like this should be a no-brainer. She almost died during a previous pregnancy. She’s got the same symptoms this time, and she’s already so sick she can’t walk. At four months, she’s still before the point of fetal viability. It’s open and shut. And apparently not. 

Why was she denied an abortion? This is why:

In Texas, a 2011 law effectively bans abortion in “hospital districts”: publicly funded entities that provide subsidized care to the poor. The only exceptions, at least for now, are cases where the fetus can’t survive outside the womb or the patient’s condition “necessitates the immediate abortion of her pregnancy to avert her death or to avoid a serious risk of substantial impairment of a major bodily function.” (A Texas lawmaker just introduced legislation to repeal the first exception.) Access to abortion is so limited in Texas that it’s difficult to pin denials of care like the one Moayedi described on any single measure. Some hospital districts refused to provide abortions except in cases of life endangerment even before legislators enshrined these restrictions in law.

While the averting death exception ought to have been enough for Dr. Moayedi’s patient, the hospital’s leadership team disagreed. They ruled that she wasn’t close enough to death for it to count. She wasn’t dying yet.

When Moayedi broke the news, the patient was devastated. She was too ill to be seen in an outpatient clinic that lacked advanced resuscitation and heart monitoring equipment. Her options were to travel to New Mexico and pay thousands of dollars for a hospital abortion there—which she couldn’t afford—or continue a pregnancy that might kill her. Like millions of people in Texas, she lacked health insurance.

Moayedi doesn’t know what happened to the patient. She never saw her again.

This is absurd.

It also doesn’t appear to be a limited problem.

After she moved to another part of Texas, Moayedi appealed to a different public hospital for a patient with a pregnancy condition that put her at risk for complications including hysterectomy and hemorrhaging. The case seemed urgent to Moayedi, who had already watched one patient who carried a pregnancy to term with this condition require a 13-unit blood transfusion—more blood than a human body typically contains.

Again, hospital leadership said no to the abortion.

“The response was that it was not actually imminently life-threatening, that sometimes people lived from the condition and so they would not intervene,” Moayedi said.

This time, Moayedi was able to refer the woman to a private hospital.

What’s going on with these hospital leadership boards? Are they ideologues themselves, or are they afraid of facing sanctions under the Texas law if they grant exceptions like these?

The way the law is being interpreted, the exception is only available for women in emergency situations who are literally bleeding out. Women whose pregnancies are high risk and carry a significant chance of death or serious complication, or side effects that may be be irreversible? They’re not literally dying right now, so it doesn’t count.

A lot of things can be obscured by terminology. We can all say the same words—“life of the woman”—and yet mean completely different things. I would assume, for example, that a woman with cancer who needs chemotherapy should be able to obtain an abortion under the “life of the mother” exemption, but I would be wrong—if she’s not dying right then it doesn’t count. At least, not for public hospitals in the states profiled in Rewire.

Here’s something I was not aware of: the refusal of public hospitals (and other hospitals) to provide abortion services for women with high risk pregnancies has led to freestanding clinics offering high-risk abortions that ought to be performed in a hospital setting, because no hospital will accommodate these women’s needs and these women’s lives are at stake. 

When such patients can’t find a willing hospital where they can afford care, it puts outpatient abortion providers in an unsettling bind. Doctors in multiple states told Rewire.News they sometimes perform abortions in clinics that should ideally be done in a hospital, because the alternative is to force patients to continue a potentially fatal pregnancy. Freestanding clinics generally lack the equipment to perform emergency hysterectomies or blood transfusions.

Yes, you read that right—some abortion providers are performing risky abortions that ought to be performed in a hospital in free standing clinics instead, because no hospital will take the woman and the pregnancy is life threatening. Better a risky abortion in a facility not designed for it than for the woman to die from a high-risk pregnancy, when those are your options.

Dr. Bhavik Kumar, an abortion provider at a stand-alone facility in Texas, said he recently safely performed an abortion for a patient whose placenta was in danger of growing into her cesarean-section scar. Another doctor had recommended the woman have her abortion in a hospital, but she said two hospitals—one that was part of a public hospital district, the other a faith-based nonprofit—refused to do the procedure. In New York, where he trained, Kumar said he “absolutely” would have referred this patient to a hospital. In Texas, he had no other option.

“For this patient, the safest thing is for her to be not pregnant as soon as possible,” Kumar said.

You know how abortion opponents have been pushing for laws requiring abortion doctors to have admitting privileges at nearby hospitals, under the argument that this makes things safer for women? Are these same lawmakers willing to get behind laws requiring hospitals to provide abortion services, because when there are complications that is after for women? 

My guess is no. 

Zeal faced this same bind when she worked at an abortion clinic in neighboring Oklahoma, which has similar restrictions on insurance and public facilities and where—as in several states with similar laws—more than a quarter of hospital beds are in Catholic facilities that oppose abortion on religious grounds.

“There were definitely patients that were referred [to the clinic] for abortion services for a life-endangering pregnancy for medical co-morbidities that in other places would definitely warrant an in-hospital procedure,” Zeal said. “But that just was not an option for them, because there was no way they could access a hospital that would provide the service.”

Read the whole Rewire article. It’s like this all the way through. It’s utterly and completely horrifying.

The patients most affected by these laws are those too sick to be seen in outpatient clinics, but not sick enough for their hospital to allow an abortion.

You’re reading that right—some women get stuck in a middle with no answer, hospitalized due to their pregnancy and at once too sick to go to a freestanding abortion clinic and not close enough to death to receive an abortion in their hospital. Typically, the solution is to look for another hospital that will take them and provide the abortion, but this can be challenging.

Chrisse France, executive director of the Cleveland abortion clinic Preterm, said it’s not unusual for providers there to deem someone too sick for outpatient care. That patient may have nowhere else to go. Private hospitals may refuse to accept her if she is uninsured or using Medicaid, which in Ohio and most other states covers abortion only for rape, incest, or life endangerment. And the public hospital, typically a safety net for poor patients, is out of the question.

“She cannot be seen at our public hospital unless pretty much she’s going to die today or maybe tomorrow,” France said. “For example, if she has cancer and needs chemo—and going without chemo is obviously bad for her health—and she wants an abortion, they can’t do it unless she’s literally ready to die.”

In the states profiled in the Rewire article, abortion is not permitted in public hospitals unless a woman’s life is in immanent danger (i.e., she is literally dying). Catholic hospitals are also off limits; these facilities tend to refuse to perform abortions unless fetal demise has already occurred (this is how Savita Halappanavar died). But the problem does not end there.

As the article notes, private hospitals may refuse to accept a patient if she is uninsured, or if she is on Medicaid, which only covers abortion if—you guessed it—a woman is literally dying (Medicaid also covers cases of rape and incest, but proving this exemption can be tricky, and even when can be obtained, the exemption is limited to women pregnant by rape or incest.)

This is the country we live in.

In Ohio, as in most of the 11 states with laws targeting public facilities, there is no exception for fetal anomalies. In December 2018, Chelsea, who asked Rewire.News not to use her last name, was about 15 weeks into a planned pregnancy when a specialist at University of Cincinnati Medical Center told her that her fetus had triploidy, a condition where three sets of chromosomes develop in each cell instead of two. Babies with triploidy are stillborn or die shortly after birth.

The news devastated Chelsea, who had suffered a miscarriage months earlier. The condition also put her at higher risk for choriocarcinoma, a fast-growing cancer, and preeclampsia, a potentially deadly pregnancy complication characterized by high blood pressure. Chelsea’s blood pressure had already been unusually high. Then the doctor delivered the final blow: Affiliated with a public university, the hospital would end her pregnancy only once Chelsea was too sick to continue it.

“My head was spinning because of the information that I was being given, but I just felt like I was on an alien planet,” Chelsea told Rewire.News. “There was no question in my mind: I’m not going to risk my organ function to carry a non-viable pregnancy to term.”

It didn’t end there, for Chelsea.

In greater Cincinnati, the last private hospital to perform abortions for fetal anomalies reportedly stopped doing so in late 2015. Deepening Chelsea’s stress was the fact that Ohio was on the verge of eliminating the procedure she needed; the week of her diagnosis, state lawmakers approved a ban on the most common and safe method of second-trimester abortion, with no exception for fetal anomalies.

Ultimately, Chelsea obtained an abortion at Planned Parenthood, but to do so she had to visit three separate times and read pamphlets about parenting and adoption, deepening her pain. Remember, this was a wanted pregnancy. Chelsea was also unable to have general anesthesia in the clinic, which meant she had to be awake for the procedure—something she didn’t want.

Oh, and the problems don’t end here, either.

Indeed, Catholic hospitals, which make up one in six acute-care beds nationwide, have sent miscarrying patients home while bleeding and in pain under religious directives that ban most abortions. A doctor at a Catholic hospital in Wisconsin told Rewire.News she had to wait overnight for a patient’s temperature to soar—a sign of infection—before she could end the pregnancy the woman was losing at 18 weeks.

At some hospitals subject to the public facilities laws, there’s a similar policy. A doctor in the Midwest, who requested anonymity, said that her institution waits for patients to run a fever if their water breaks long before fetal viability—a scenario where infection is all but inevitable.

We’re talking about miscarriages—when a woman’s water breaks before fetal viability, her fetus cannot survive. There’s a reason hospitals induce women at term if their water breaks and labor does not begin within 24 hours—the risk of infection is high. If a woman’s water breaks before viability and she does not miscarry, she needs an abortion.

According to the Rewire article, some Catholic hospitals and public hospitals have an actual policy of waiting for a woman in such a situation to run a fever, indicating that infection is setting in. Then they can justify performing an abortion.

Is it any surprise our maternal mortality rate looks like this?

What’s a woman’s life worth? I’m reminded of Chelsea’s statement: “I’m not going to risk my organ function to carry a non-viable pregnancy to term.” Perhaps the question is not so much what is a woman’s life worth as it is what is a woman’s body worth. Or maybe, what is a woman’s health worth. Chelsea was told that she could be given an abortion the moment she was “too sick” to continue her pregnancy—hence the organ function comment. Chelsea’s life would be saved—but her health? Not so much. That politicians are willing to gamble with.

I can’t help but feel that this wouldn’t be happening if men could get pregnant too. Would men be expected to risk organ function to carry a nonviable pregnancy—or any pregnancy? Somehow I doubt it. 

As supportive as I am of universal healthcare, stories like Rewire’s have me worried. If we had universal healthcare—a system like those in most other western countries, where doctor’s visits and medical procedures are covered at now cost, funded by tax dollars—what would women’s access to abortion look like? Conservatives have already attempted to ban health clinics that provide abortion services from receiving public Medicaid funding for other services they offer—imagine how much worse this could be if all medical funding was public.

Women’s health ought to be a place everyone can come together. We’re not talking about your average run-of-the-mill elective abortion. Conservatives believe that the fetus is a person with rights; we’re talking about cases where there’s a second life at stake—the woman’s. In a contest between the two, surely women should be allowed to choose their own.

But then, that may be why we’re where we are—if a woman is literally dying, according to these laws and policies, she can have an abortion. But if she only might die—or if she might be physically impaired—that is a risk she ought to be willing to run, for the sake of the other life.

But you know what? That ought to be the woman’s decision. We don’t legally sanction people who don’t run into burning buildings to save children. We shouldn’t legally sanction women who aren’t willing to risk their health to continue a pregnancy.

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March 11, 2019

Last week, a friend sent me an article bearing the headline They Are Real: Meet Born-Alive Abortion Survivors. Could I maybe blog about it, she asked? This article led me down to a rabbit hole with numbers that kept getting bigger. When I reached an article that argued that there are 44,000 abortion survivors living in the U.S. today, I knew we had a definitional problem. What is really going on here?

The article my friend sent me profiled five individuals it labeled “abortion survivors.” These individuals are real people. The first one profiled Gianna Jesson, whose mother had a saline abortion at 30 weeks in 1977, and Gianna survived. When she was born alive, she was provided with care and given up for adoption. Melissa Ohden’s biological mother had a saline abortion at 31 weeks in 1977; she, too, survived and was provided care.

The other three individuals profiled had a bit of a different story. They were each born to mothers who had attempted abortions earlier in their pregnancies; in each case, the abortion failed to terminate the pregnancy. (I suspect that these individuals are not what most people mean when they hear of “born-alive abortions survivors.”)

Abortions like those Gianna and Melissa survived are not practiced today. Abortions past the point of viability are expensive and difficult to obtain, and are typically only offered in case of severe fetal abnormality, or other severe cases. Their mothers would be unlikely to access abortions at 30 weeks today. For another thing, saline abortions were deemed unsafe; popular in the 1970s, this procedure has fallen into obscurity.

Before I go deeper in, a few things are worth noting.

First, abortion procedures have changed over the past five decades.

We need to be careful about assuming, based on a story from the 1970s or 1990s, that a procedure would take place again today as described. Many of the horror stories thrown around are decades old, and do not necessarily reflect practices in the present.

Second, pay attention to what numbers are actually counting.

Abortion opponents have long declared that hundreds of babies have survived abortions in Canada, only to be left to die. They base this claim on a specific mortality code: P96.4, Termination of Pregnancy. The problem? This mortality code includes miscarriages where a premature infant is born alive and does not survive.

Third, “born alive” does not mean viable.

Comfort care is sometimes the best (or only) option for a severely premature infant (regardless of the reason for its preterm birth). There are many cases where a woman delivers too early for an infant to have high chances of survival, and chooses to offer only comfort care, holding the infant while it passes. We consider this acceptable care.

Fourth, killing an infant born alive is considered murder.

Under a law passed in 2002, infants born alive are legally persons regardless of their developmental level. By law, they must be afforded the same rights and care as any other infant born alive. This is why infamous illegal abortion doctor Kermit Gosnell was able to be convicted of the murder of three infants.

Fifth, abortion procedures are designed to ensure fetal demise.

The International Federation of Gynecologists and Obstetricians recommends the administration of a feticide for any abortion past 22 weeks to prevent live birth. After this point, doctors frequently begin abortion procedures by administering an injection directly into the heart to stop the fetal heartbeat.

Abortions that occur later in pregnancy are not an easy thing to talk about; that may be why abortion opponents would rather talk about it than about their efforts to close abortion clinics and end women’s access to first trimester abortions. Abortions after the 20th week of pregnancy tend to be performed due to severe fetal abnormality. In many cases, the fetus is not compatible with life.

According to data from the CDC, there were an average of 12 fatalities of infants born alive during an abortion procedure each year between 2003 and 2014. In the UK, an average of 10 infants born alive during an abortion died each year between 1995 and 2004; that number was higher at the beginning of the period and lower at the end, as procedures and guidelines changed.

What is going on here? High resolution ultrasounds designed to identify fetal abnormalities are conducted at 18-20 weeks of pregnancy. As a result, abortions due to fetal abnormalities typically occur around 20-24 weeks. At 20 weeks, a fetus has 0% chance of survival out of the womb. At 24 weeks, a fetus has a 40-70% chance of survival out of the womb. The most common abortion procedure used at this gestation is surgical—in these cases, there is no chance of fetal survival. In other cases, though, a different procedure is used: induction of labor.

Induction of labor is exactly what it sounds like—medication is used to induce premature labor, expelling the fetus. In most cases fetal demise will occur in the process of delivery. When using this procedure at and after 22 weeks of gestation, it is routine to inject a feticide into the heart of the fetus, through the mother’s stomach, before inducing labor (this recommendation did not exist in the 1970s). Some women aborting due to severe fetal abnormality opt not to have the feticide, preferring to hold their infant while she dies. Sometimes, too, fetuses younger than 22 weeks are born alive, but with no chance of survival. These infants are provided with comfort care.

In the UK, infants born alive in the process of an abortion varied between 17 and 33 weeks in gestational age, and had a mean gestational age of 21 weeks (i.e. half were born at less than 21 weeks, and half at more). While data on these infants’ gestational age in Canada does not disaggregate between infants born alive as the result of miscarriages and those born alive as the result of abortions, only 5% of overall fatalities among infants born alive as the result of termination of pregnancy (whether abortion or miscarriage) occurred after 24 weeks (which has a 40-70% chance of survival); a full 20% occurred at week 20 (which has a 0% chance of survival) or before.

Sometimes doctors do not follow the law. Sycloria Williams was 23 weeks pregnant when she went to a clinic for an abortion procedure in 2006. She was given pills to induce pregnancy. A feticide was not administered. The doctor did not show up. Williams went into premature labor and delivered an infant. According to Williams, the baby was breathing and moving. At 23 weeks, her infant had a 10-35% chance of survival. The attendant, who did not have a medical license, put the baby in a sealed biohazard bag and put her in the trash can. No medical care was given to Williams, who had just given birth. The doctor arrived an hour later. He was investigated and he lost his license.

What happened in Williams’ case should not have happened. For starters, the doctor should have actually been present. For another thing, if the procedure was an induction of labor, a feticide should have been administered first. And finally, if the procedure resulted in an infant born alive, that infant should have been provided care.

Here things get dicey—what care? Comfort care? Or more aggressive interventions? Remember, most infants born alive in such circumstances are far younger than Williams’ was at 23 weeks. An infant born alive at 21 weeks, regardless of circumstances, is not viable. Providing interventions to an infant that is not viable can be cruel.

One solution is to opt out of this question altogether—this is where the feticide comes in. In the UK, after guidelines changed to make feticide more standard in cases of abortion at or after 22 weeks, the number of infants born alive dropped. U.S. guidelines now also recommend feticide at or after 22 weeks.

There’s another thing to consider—if women had better access to abortion, they would be less at the mercy of hatchet doctors like the one Williams visited, or Kermit Gosnell. If you could go to your doctor for an abortion like you might for an IUD insertion—and if women had more widespread access to affordable, high quality health insurance that covered these procedures—the Kermit Gosnells would be out of business. If you could go to your doctor for the procedure, you’d also likely be in a better clinic—maybe even a hospital—if something went awry.

But no. Largely as a result of the anti-abortion movement, abortion has been widely confined to separate clinics.

In the past few months, abortion opponents have honed in on what care should be provided for infants born alive in the process of an abortion, but it is important to remember that is not where their concern ends. To see this in action, when you next speak with an abortion opponent concerned about infants born alive during the procedure, try suggesting a law mandating that doctors who perform induction of labor procedures after 20 weeks of gestation ensure that fetal demise has taken place (i.e. via feticide) before inducing labor, with sanctions for failure to do so.

I am not suggesting such a law, because I am not a medical provider with expertise in this area and because hamstringing doctors with rules written by lawmakers can create unforeseen side effects. Still, such a bill would address concerns about infants born alive during the process of an abortion just as effectively as other legislation being thrown about, if not more so. And yet no abortion opponent is going to see that as a solution, because they view abortion itself as murder.

And here we are. If you’re just after basic facts, you’ve got some now. With the rest of this article, I’m going to delve more deeply into the numbers, tracing my own journey as I hunted down statistics and compiled articles. Feel free to join me!

All About Those Numbers

Remember that 44,000 number I referenced briefly? That number came from Christina Dunigan, an anti-abortion blogger who argued that there were 44,000 abortion survivors living in the U.S. today. We’re going to examine that number first because it offers a helpful lead-in before going too deeply into the issues.

The article my friend sent me profiled five individuals: two were born alive in 1977 in the process of botched abortions around 30 weeks of pregnancy, but the other three were born later to women who had earlier had abortions that had failed to end their pregnancies. Dunigan’s claims fit into these same two categories.

From Dunigan’s post:

Research indicates that between about 850 and 1,800 unborn children survive first-trimester abortion attempts in the US every year. We don’t have numbers on what percent of women change their minds about wanting their babies to die and continue their pregnancies…. I’ll just aim for the middle and say that half of those children get to be born alive. That’s about 1,325 survivors of early abortions every year, about 662 of whom are permitted to live to be born. That’s 25,000 (rounded down) since Roe.

Yes, some first-trimester abortions fail. Up to 5% of medication (pill) abortions fail to complete, while fewer than 1% of surgical abortions fail to complete. Given the rising number of women using medication abortions, Dunigan’s numbers on the number of failed first trimester abortions are likely low. However, Dunigan’s guess that 50% of women whose first trimester abortion fails to end their pregnancy change their mind is almost certainly way off.

Women who have abortions are expected to come in for a followup two weeks after the procedure to verify that their abortion completed. If they are still pregnant, these women are offered a second procedure, typically at no additional charge, to complete the abortion. This is understood as routine. Women who have medication abortions especially are informed from the outset that they may have to have a surgical abortion as a followup.

Everything I’ve read indicates that a first-trimester abortion that fails to complete is almost universally followed by a second procedure. Yes, some women may decide to go through with their pregnancy after a failed pregnancy, but that number is nowhere near 50%. Women who do decide to continue their pregnancies may face complications with their pregnancy or fetus. Some infants will be born with deformities; others may be normal.

Are there some people whose mothers had a failed first trimester abortion and decided not to have a followup procedure? Certainly. There are also some people out there whose mothers were turned away from abortion clinics because they waited too long, and people out there whose mothers considered abortion and decided against it. None of these individuals are typically what people think of when they hear of “born alive abortion survivors.”

What about the second part of Dunigan’s 44,000 number? This is the category Gianna Jesson and Melissa Ohden are in. It’s what people typically mean when they reference “born alive abortion survivors.”

Dunigan writes as follows:

Based on the only report we ever got out of the Centers for Disease Control on the subject, abortionists reported about 500 babies surviving later abortion attempts every year. Times 38 years of abortion on demand, that’s 19,000.

I was unable to find anything from the CDC saying that 500 babies survive later abortion attempts each year. This does not appear to be an actual statistic. (I did find other numbers from the CDC, which we’ll get to later.) Dunigan may have misunderstood, interpreting a number that covered a decade more more as an annual sum, and using a statistic that includes infants who are born alive during miscarries and do not survive.

Even if Dunigan’s claim were correct, it’s odd that she would assume these 500 infants would all survive. First, as we know, infants who are born alive in the course of an abortion are typically too premature to survive, and often suffer from fetal defects that make their survival only less likely. Second, though, if the anti-abortion movement is concerned with these infants allegedly being killed, it’s odd that Dunigan would assume they all survive.

I reference Dunigan in part to show you how wild these claims can get, and in part because I found a surprisingly large number of pro-life sites that took her seriously in the course of my research.

At this point, we are going to part ways with Dunigan.

What Is “Termination of Pregnancy”? 

Many abortion opponents both in the U.S. and in Canada who have raised concern about infants born alive during an abortion procedure point to a specific mortality classification: Termination of Pregnancy [P96.4]. But here’s the problem: according to the CDC, “this category includes spontaneous terminations of pregnancy and induced terminations of pregnancy.” P96.4, in other words, includes miscarriages that involve live births. Many abortion opponents tout the CDC’s P96.4 category without understanding that this category also includes miscarriages. (You can see an article to this effect from the conservative American Center for Law and Justice here.)

In response to a Congressional inquiry regarding which P96.4 fatalities involve induced abortion, following the discovery of Kermit Gosnell’s horrific illegal abortion clinic, the CDC published a report identifying which P96.4 fatalities were the result of induced abortions. The CDC data showed 588 deaths classified as P96.4 from 2003 to 2014; of these, the CDC was able to identify just under a quarter as involving an induced abortion.

The CDC explained as follows:

Analysis of the text as reported by the cause-of-death certifier show that of 588 deaths [from 2003-2014] with mention of P96.4, 143 (24.3%) could definitively be classified as involving an induced termination.

The report lists 143 deaths among infants born alive after an abortion procedure over the course of 12 years. The report included this breakdown regarding how long these infants lived before they died:

Age at death Frequency Percent
<10 minutes 25 17.5
10-59 minutes 35 24.5
1-4 hours 68 47.6
5-23 hours 9 6.3
1 day or more 6 4.2

The chart above is not evidence of foul play.

First, the report did not state how many weeks along these infants were, which would help tell us whether they were actually viable. Next, the report did not state what care these infants were offered, and whether these infants were offered interventions beyond comfort care—although we can assume, I think, that the six infants who survived more than a day received more than comfort care. Finally, the report also did not state how many infants born alive after an induced termination may have survived (P96.4 only includes fatalities).

A data request for cases listed with the P96.4 fatality code in Canada resulted in this breakdown (remember that this includes deaths among infants born alive as the result of both miscarriages and induced abortions):

Gestational age Percent
13-16 0%
17-20 19%
21-24 76%
25-28 4%
29 + 1%

An infant being born alive after an abortion is not necessarily a sign that something went wrong. Why? Because some women who abort due to severe fetal abnormality want to hold their child while he passes.

The death of an infant born alive during an abortion procedure is also not necessarily evidence of infanticide. Why? Have a look at the numbers in the chart above. The 19% born in weeks 17-20 would not been non-viable. While the numbers do not break down the 76% that were born between week 21 (0% chance of survival) and week 24 (40-70% chance of survival), we can theorize that the breakdown is heavily loaded at the beginning, given that similar data in the UK found that the mean age was 21 weeks. This means that most of these infants were not viable due to prematurity alone. The 5% at or after 25 weeks were very likely to have fetal defects, making survival less likely.

One anti-abortion writer says this of the CDC’s 143 recorded born alive abortion-related fatalities:

That is to say, at least 143 infants died after they were born alive following abortion, whether due to injuries sustained as a result of the abortion attempt, due to active neglect or denial of care of injured or preterm infants or some combination of both.

Do you see what’s missing? He writes that these babies died either “due to injuries” sustained during the abortion attempt or “due to active neglect or denial of care.” This is balderdash. If the breakdown of these cases is anything like those in Canada or the UK (which we’ll look at in a moment), the vast majority of these cases had not reached the point of viability. Further, most abortions performed after 20 weeks are due to fetal abnormalities, which in some cases may themselves render the infant incompatible with life.

When abortion opponents talk about infants born alive during an abortion procedure, they tend to focus on cases like Kermit Gosnell, who ran a “house of horrors” illegal abortion clinic. Conditions at Gosnell’s clinic were unsanitary. Women died, or suffered horrendous complications. When infants were born alive in his clinic, Gosnell snipped their spinal cords. Gosnell was sentenced to life in prison, and he deserves everything he got.

But this is the important part: Gosnell was convicted of the murder of three infants, under existing law. What he did was illegal. It is against the law to kill infants born alive in the process of an abortion procedure. That is murder. He got caught, he got charged, and he got put away. The system ultimately worked.

It is a horrendous mistake to assume that all 143 abortion-related P96.4 deaths reported to the CDC were like those of the infants at Gosnell’s clinic. We are talking about infants born extremely prematurely. Consider this: between 2003 and 2014, there were 445 infant deaths due to miscarriage. These were infants that were also born alive, and also then died. Why? Because they were born prematurely; not because of foul play. There is every reason to assume the same of the 143 CDC recorded abortion-related born-alive infant fatalities from 2003-2014.

Let’s turn, for a moment, to a 2007 study from the UK. This study examined all “terminations of pregnancy for fetal anomaly (TOPFAs)” in a database of pregnancies with congenital anomalies. Of the 3,189 TOPFAs identified between 1995 and 2004, there were 102 cases of live birth. Researchers found as follows:

Of the 102 live births [recorded between 1995 and 2004], the gestation ranged from 17 to 33 with a median of 21 weeks. The survival duration for liveborn TOPFAs was a median of 80 minutes. Thirty‐seven cases survived for 1 hour or less and six cases survived 6 hours or more.

The proportions of live births at different gestations were 14.7% between 16 and 20 weeks; 65.7% between 20 and 24; and 19.6% at or after 24 weeks.

The chance of survival of an infant born alive at 21 weeks is 0%. These chances go up slightly each week, reaching a 40-70% chance of survival at 24 weeks and a 90% chance of survival at 27 weeks. And remember—abortions performed during these weeks frequently involve fetal abnormalities that make chances of survival even lower.

When an infant is born prematurely (or with abnormalities that make her incompatible with life), parents typically choose whether to give her comfort care while she passes or whether to offer more aggressive interventions. Under current law, infants born alive during abortion procedures are to be afforded the same care.

The Born Alive Infants Protection Act of 2002

Let’s take some time to look at the Born Alive Infants Protection Act, passed in 2002, and Jill Stanek. I’ll give you Stanek in her own words, from testimony before Congress during the debate over the bill. Quick warning—this gets a bit graphic. If you’d rather skip the quotes here and read my summaries, feel free to do so.

Stanek’s testimony began as follows:

I am a Registered Nurse who has worked in the Labor & Delivery Department at Christ Hospital in Oak Lawn, Illinois, for the past five years. Christ Hospital performs abortions on women in their second or even third trimesters of pregnancy. Sometimes the babies being aborted are healthy, and sometimes they are not.

The method of abortion that Christ Hospital uses is called “induced labor abortion,” also now known as “live birth abortion.” This type of abortion can be performed different ways, but the goal always is to cause a pregnant woman’s cervix to open so that she will deliver a premature baby who dies during the birth process or soon afterward. The way that induced abortion is most often executed at my hospital is by the physician inserting a medication called Cytotec into the birth canal close to the cervix. Cytotec irritates the cervix and stimulates it to open. When this occurs, the small, preterm baby drops out of the uterus, oftentimes alive. It is not uncommon for one of these live aborted babies to linger for an hour or two or even longer. One of them once lived for almost eight hours.

In the event that a baby is aborted alive, he or she receives no medical assessments or care but is only given what my hospital calls “comfort care.” “Comfort care” is defined as keeping the baby warm in a blanket until he or she dies, although even this minimal compassion is not always provided. It is not required that these babies be held during their short lives.

One night, a nursing co-worker was taking an aborted Down’s Syndrome baby who was born alive to our Soiled Utility Room because his parents did not want to hold him, and she did not have time to hold him. I could not bear the thought of this suffering child dying alone in a Soiled Utility Room, so I cradled and rocked him for the 45 minutes that he lived. He was 21 to 22 weeks old, weighed about ½ pound, and was about 10 inches long. He was too weak to move very much, expending any energy he had trying to breathe. Toward the end he was so quiet that I couldn’t tell if he was still alive unless I held him up to the light to see if his heart was still beating through his chest wall. After he was pronounced dead, we folded his little arms across his chest, wrapped him in a tiny shroud, and carried him to the hospital morgue where all of our dead patients are taken.

In the late 1990s, Stanek was a nurse in the labor and delivery ward at Christ Hospital in Oak Lawn, Illinois. While she did not participate in the abortions that were performed there, she heard stories from nurses who did. The procedure typically used was called an “induced labor abortion” or a “live birth abortion”: drugs are used to induce labor, and the pregnant woman gives birth prematurely. According to a Christ Hospital spokesperson, “between 10 percent and 20 percent of fetuses with genetic defects that are aborted survive for short periods outside the womb.”

When an infant was born alive during an induced labor abortion, Stanek reported, that infant would be provided comfort care. Stanek went public with concerns about what she had seen at Christ Hospital for two reasons: First, she did not feel that the comfort care provided was adequate. (She spoke of a time when she came upon a nurse on her way to leave a premature infant in a utility room to die because she did not have time to hold it and the parents did not want to; Stanek held it so it would not die alone.) Second, Stanek argued that the induced labor procedure was used in cases where it should not have been, such as for non-fatal abnormalities like Down syndrome.

A description of Stanek’s criticism of Christ Hospital’s procedures, as well as similar criticism from other nurses, is included in a Congressional report on the Born Alive Infants Protection Act, which was passed in 2002:

According to medical experts, this procedure [“induced labor” or “live-birth” abortions] is appropriately used only in situations in which an unborn child has a fatal deformity, such as anencephaly or lack of a brain, and infants with such conditions who are born alive are given comfort care (including warmth and nutrition) until they die, which, because of the fatal deformity, is typically within a day or two of birth. According to the testimony of Mrs. Stanek and Mrs. Baker, however, physicians at Christ Hospital have used the procedure to abort healthy infants and infants with non-fatal deformities such as spina bifida and Down Syndrome. Many of these babies have lived for hours after birth, with no efforts made to determine if any of them could have survived with appropriate medical assistance. The nurses have also witnessed hospital staff taking many of these live-born babies into a ‘‘soiled utility closet’’ where the babies would remain until death. Comfort care, the nurses say, was only provided sporadically.

The Born Alive Infants Protection Act definitively stated that any fetus that was expelled from its mother and showed signs of life, regardless of its developmental stage, was a person. This is why Kermit Gosnell could be tried for murder. Infants born alive as the result of an abortion have the same rights as any other infant born alive.

The Use of Feticide in Later Abortions

If you’ve read the wrenching stories of women who had late term abortions that have proliferated in the past few months, you may have noticed a common theme—before inducing labor, their doctors gave them an injection that stopped the fetal heartbeat. In fact, if you’ve read enough of these stories, you may have been scratching your head in confusion when reading Stanek’s testimony. There’s a good reason for that.

In June 2007, the International Federation of Gynecology and Obstetrics’ Committee for the Ethical Aspects of Human Reproduction and Women’s Health released a report titled Ethical Aspects Concerning Termination of Pregnancy Following Prenatal Diagnosis. Translated into plain English, this was a report from the International Federation of Gynecology and Obstetrics that made recommendations on ethical issues surrounding abortions performed due to fetal abnormality. Feel free to read the whole thing.

The report included this recommendation:

Termination of pregnancy following prenatal diagnosis after 22 weeks must be preceded by a feticide starting with the injection into the fetal circulation of anesthetics and anti-pain medication.

This recommendation was made in 2007. It may not have been in practice at Christ Hospital when Stanek worked there: the hospital may have been simply inducing labor, and not administering feticide. And that may be why, as a Christ Hospital spokesperson stated, “between 10 percent and 20 percent of fetuses with genetic defects that are aborted survive for short periods outside the womb.” That’s a really high number!

On this pregnancy forum thread, women who had late term abortions discuss whether or not they were offered feticide beforehand. Several state that their doctors did not think it necessary, because their fetuses had such severe abnormalities they were unlikely to survive the birthing process.

Another quick look at the TOPFA study from the UK is of interest:

Within our study 3.2% of TOPFAs result in a live birth. The proportion has reduced significantly over the period of this study from 4.0% in 1995 to 1.7% in 2004. In particular, those of 22–23 weeks gestation have reduced significantly over the period of this study from 6.5% in 1995 to 3.0% in 2004. This is likely to be due to the impact of guidelines issued [in 1998] by the RCOG [Royal College of Obstetricians and Gynecologists], that feticide should be offered to ensure that live birth does not occur following TOPFA after 22 weeks. Our data show a significant chance of live birth at 20 and 21 weeks, which we have quantified as being 3.5% and 5.4%, respectively. The RCOG guidelines do not recommend feticide at these gestations.

In 1998, the Royal College of Obstetricians and Gynecologists changed their recommendations to state that feticide should be offered in all TOPFAs (termination software pregnancy for fetal abnormality) performed at or after 22 weeks. As a result, the rate of TOPFAs that resulted in live births fell from 4.0% to 1.7%. The researchers further recommend extending that guideline to 21 weeks for cases where fetal abnormalities are less imminently lethal.

We can have a conversation about what renders an abnormality severe enough to indicate abortion. I am myself  uncomfortable with the rate of abortions due to indication of Down syndrome. But I also think that we need to have other conversations—are we as a society doing enough to support families that raise children with disabilities? What standards should be set for when doctors encourage termination, and when they should not? Do doctors offer women pregnant with a fetus with trisomy 21 contact info for local support groups, before they decide?

I want to bracket that conversation here, though, because that is not the topic of this post. Instead, I want to focus more specifically on the topic at hand: over time, abortion procedures have been adjusted to ensure that an abortion will not result in an infant being born alive. Indeed, the UK-based Nuffield Council on Bioethics’ report on critical care decisions in fetal and neonatal medicine: ethical issues contains the following:

The Abortion Act 1967 only permits termination of pregnancy after 24 weeks if a fetus is at “substantial risk of serious handicap or there is a risk of grave permanent injury to the woman”. For terminations at 22 weeks or later, feticide (ending the life of the fetus, usually by lethal injection into the heart) is usually carried out to ensure that a baby is not born alive. When a woman does not want feticide, some doctors may have concerns because they believe that they are legally obliged to try to save a baby who shows signs of life when born. However, there is no legal obligation to prolong the life of a baby when they have no hope of survival or they will suffer more than benefit from the treatment. What is done should be appropriate to the baby’s condition.

The Council recommended that healthcare teams develop codes of practice that make clear what the law does and does not require doctors to do, and that pregnant women be given information about “possible outcomes if a baby is born alive following termination on grounds of fetal abnormality.” This seems completely reasonable.

What Is a Live Birth?

I want to take a moment to quote from a blog post published last week by Dr. Jen Gunter, an OB/GYN who has performed abortions. I’m an OB/GYN and infanticide is not part of abortion care, Gunter wrote.

Gunter discusses what a “live birth” means:

This is the definition that most states use for live birth:

‘‘Live Birth’’ means the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy, which, after such expulsion or extraction, breathes, or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.

The key part is the last sentence: Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.

Movement or cardiac activity does not equate life, by the medical and the legal definitions.

Whether a birth is recorded as “live” in situations of extreme prematurity or fetal anomalies — the kind of situations we are talking about — is not cut and dried. For example, when my son Aidan [one of three triplets] was born at 22 1/2 weeks I was asked if I wanted his birth to be considered a live birth? It was my choice.

I had no idea? I mean he lived 3 minutes or so, but he could never live a life. What a live birth got me was a birth certificate. I said yes, but in retrospect I wished I hadn’t. A live birth meant he was now a hospital patient and so I was charged $600 for the care he received — a blanket and a nurse holding him. Why was I charged? As he lived 3 minutes I obviously didn’t apply for health insurance. With no insurer to bill, I was charged for his post delivery care as if he were a term infant in the hospital for less than 24 hours. Nice, huh?

It was super special fighting that bill with collections when my other two boys [born at 26 weeks] were in the neonatal intensive care unit struggling to not die. So awesome the forced birth advocates are involved in helping women like me when we are literally penalized for having a live birth. (Heavy sarcasm).

The take away —  a live birth does not mean a life is possible. There is a huge difference. And, the recording of a live birth can be fluid based on parental wishes.

What counts as a “live birth”? Of the 143 CDC-reported fatalities among live births after an induced abortion, 25 lived less than 10 minutes. So, too, there’s the issue of viability—an infant can be alive, but not be viable.

Gunter writes as follows:

Most Abortions Can’t Possibly End in a Live Birth Because They are Abortions

I can’t believe I have to spell this out either. I mean, really?

[A]bortions at or after 23-24 weeks—the only theoretically possible “live birth scenario”— are done by two methods: surgical or induction of labor.

A surgical abortion does not in any situation result in a live birth. It’s not possible. The end.

So that leaves induction of labor. Again, these are almost always severe fetal anomalies, so the live birth scenario is preposterous and, quite frankly, offensive to those patients who are living the tragedy. Many patients have a procedure to stop fetal cardiac activity before the induction, so fetal demise has already occurred. Some providers think this may shorten the time it takes for induction. And some patients prefer it. Often there is fetal demise during labor, because that is what happens with severe fetal anomalies. In the rare scenario where there is a live birth, parents hold their baby for comfort care.  

Abortion opponents point to rare cases where these guidelines aren’t followed, like Williams’ case. But that case was plagued by malpractice. The abortion doctor failed to show up and was not even present. Reading between the lines, it sounds like a surgical abortion was intended, but after Williams took medication to soften her cervix, the doctor was not there, so she sat there until she went into labor. Wrong, wrong, wrong. The doctor lost his license.

Gunter also discusses Gosnell, and then notes:

Legal, available, affordable abortion prevents back alley and clandestine procedures. If you want to prevent infanticide from predators, stop writing laws that restrict abortion.

It’s that simple.

Conclusion

While abortion doctors estimate that the vast majority of abortions after 20 weeks are performed in cases of fetal abnormality, abortion opponents disagree with this claim. One anti-abortion article I saw linked to a study of women who have had abortions that included a number of women who had abortions between 20 and 24 weeks due to not knowing they were pregnant earlier, or having difficulty access abortion care earlier.

The alter abortions are performed, the more they cost and the greater the associated health risk. To the extent that women are having abortions past 20 weeks for reasons other than fetal abnormality, we need to look at reasons that delay these women from seeking abortion earlier and work to remedy them. We need better sex education, to help ensure that women will recognize when they are pregnant. We need better access to medical care, so that women have a doctor and the ability to book an appointment if they have questions about their health. And, of course, we need better access to abortion care, so that women aren’t required to drive hours away from home.

Those eager to disentangle later abortions from fetal abnormalities (in an attempt to turn public opinion against later abortions) oppose the very things that would decrease the number of later abortions performed for reasons other than fetal abnormality. This means that there is a serious level of disingenuousness at play.

In 2013, after Kermit Gosnell’s house of horrors was discovered, the House Judiciary Committee asked each state’s attorney general whether “prosecutors in your state treat the deliberate killing of newborns, including those newborns who were delivered alive in the process of abortions, as a criminal offense.” Attorney generals across the country responded that they would, and submitted reports. No widespread problems were revealed.

As I reflect on all of this, it seems to me that the central contention—beyond disagreement over numbers—is what care should be provided in cases where an infant is born alive during an induction of labor abortion. If current guidelines are followed, cases that occur at or after 22 weeks of gestation involve the administration of a feticide before inducing labor. These infants should not be born alive. Infants younger than this may be born alive, in rare cases, but they are not viable—babies born at 21 weeks of gestation or earlier cannot survive.

Administering aggressive interventions to a nonviable infant is cruel. What an infant in these circumstances needs is to be kept warm and held until she passes. I’m reminded of the death of one of my great-grandmothers. When the paramedics arrived after she had already passed, they wanted to restart her heart. My mother disagreed. My great-grandmother was gone. We didn’t need more trauma—and her body didn’t either. The same is true here.

That said, any infant born alive during the course of an abortion should be assessed to determine whether it is viable, and if it is viable, it should be provided more than comfort care. This is currently required by law; doctors who do not respond appropriately risk sanctions. But remember, these born alive cases are rare, and in the vast majority of them, the correct assessment will be comfort care. Lawmakers should be careful about legislating specific aspects of medical procedures. They are not doctors, and unintended consequences are far too common.

I appreciated the UK guidelines I quoted from earlier, which advised medical teams to come up with guidelines outlining what care should be provided for in the unlikely case that an infant is born alive in the course of a later abortion—and to ensure that women who undergo these procedures are aware of these guidelines.

I dearly wish we could just let medicine be medicine, and divorce it from politics. The fraught political climate around abortion isn’t helping. The partisanship gets in the way of honestly discussing real issues.

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